Provider Demographics
NPI:1003175100
Name:TAYLOR, JENNIFER JO (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RUSSELL ST NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3602
Mailing Address - Country:US
Mailing Address - Phone:256-651-2413
Mailing Address - Fax:877-228-0054
Practice Address - Street 1:200 RUSSELL ST NE FL 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-651-2413
Practice Address - Fax:887-228-0054
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional